Chapter 8/9 Lecture Outline Copyright (c) The McGraw-Hill Companies, Inc. Permission required for...

Chapter 8/9Lecture Outline

Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

9-1

9-2

Joints• Joints and Their

Classification– bony joints– fibrous joints– cartilaginous joints

• Synovial Joints– general anatomy– joints and lever systems– movements of synovial joints

• Anatomy of Selected Diarthroses– jaw joint– shoulder joint– elbow joint– hip joint– knee joint– ankle

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

© Gerard Vandystadt/Photo Researchers, Inc.Figure 9.1

9-3

Joints (Articulations)• joint (articulation) – any point where two bones

meet, whether or not the bones are movable at that interface

• arthrology – science of joint structure, function, and dysfunction

• kinesiology – the study of musculoskeletal movement– a branch of biomechanics – deals with a broad

variety of movements and mechanical processes in the body, including the physics of blood circulation, respiration, and hearing

9-4

Joints and Their Classification

• joint name – typically derived from the names of the bones involved– atlanto-occipital joint, glenohumeral joint, radioulnar joint

• joints classified according to the manner in which the adjacent bones are bound to each other, with differences in how freely the bones can move

• four major joint categories:– bony joints– fibrous joints– catilaginous joints– synovial joints

9-5

Bony Joint (Synostosis)

• bony joint, or synostosis – an immovable joint formed when the gap between two bones ossify, and they become in effect, a single bone– frontal and mandibular bones in infants– cranial sutures in elderly– attachment of first rib and sternum with old age

• can occur in either fibrous or cartilaginous joint

9-6

Fibrous Joints (Synarthrosis)

• fibrous joint, synarthrosis, or synarthrodial joint – a point at which adjacent bones are bound by collagen fibers that emerge from one bone, cross the space between them, and penetrate into the other

• three kinds of fibrous joints– sutures– gomphoses– syndesmoses

9-7

• sutures - immovable or slightly movable fibrous joints that closely bind the bones of the skull to each other

• sutures can be classified as:

– serrate – interlocking wavy lines• coronal, sagittal and lambdoid

sutures

– lap (squamous)- overlapping beveled edges

• temporal and parietal bones

– plane (butt)- straight, nonoverlapping edges

• palatine processes of the maxillae

Fibrous Joints - Sutures

Figure 9.2a


Fibrous connective tissue

Types of SuturesCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Wood

Dovetail joint Miter joint Butt joint

Bone

Serrate suture Lap suture Plane suture

9-8

Figure 9.3

9-9

Fibrous Joint - Gomphoses• gomphosis -

attachment of a tooth to its socket

• held in place by fibrous periodontal ligament– collagen fibers attach

tooth to jawbone– allows the tooth to move

a little under the stress of chewing



(b) Gomphosis

Figure 9.2b

9-10

• syndesmosis – a fibrous joint at which two bones are bound by longer collagenous fibers than in a suture or gomphosis giving the bones more mobility– interosseus membrane

• most movable syndesmosis– interosseus membranes

unite radius to ulna allowing supination and pronation

• less movable syndesmosis– tibia to fibula

Fibrous Joint - SyndesmosisCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.


(c) SyndesmosisFigure 9.2c

9-11

Cartilaginous Joints

• cartilaginous joint, amphiarthrosis or amphiarthrodial joint – two bones are linked by cartilage

• two types of cartilaginous joints– synchondroses– symphyses

9-12

Cartilaginous Joint - Synchondrosis

• synchrondrosis - bones are bound by hyaline cartilage

– temporary joint in the epiphyseal plate in children

• binds epiphysis and diaphysis

– first rib attachment to sternum

• other costal cartilages are joined to sternum by synovial joints

Figure 9.4a,b

Pubic symphysis

Clavicle

Rib 1

(a)

(b)

Sternum

Costalcartilage

Interpubic disc(fibrocartilage)


9-13

Cartilaginous Joint - Symphysis• symphysis - two bones

joined by fibrocartilage

– pubic symphysis in which right and left pubic bones joined by interpubic disc

– bodies of vertebrae and intervertebral discs

• only slight amount of movement between adjacent vertebrae

• collective effect of all 23 discs gives spine considerable flexibility

Pubic symphysis

Body of vertebra(c)

(b)

Interpubic disc(fibrocartilage)

Intervertebraldisc (fibrocartilage)


Figure 9.4b,c

9-14

Synovial Joint• synovial joint, diarthrosis or diarthrodial joint – joint in which two bones are separated by a space called a joint cavity

• most familiar type of joint

• most are freely movable

• most structurally complex type of joint

• most likely to develop painful dysfunction

• most important joints for physical and occupational therapists, athletic coaches, nurses, and fitness trainers

• their mobility make them important to quality of life


Periosteum

Ligament

Bone

Proximalphalanx

Joint cavitycontainingsynovial fluid

Fibrouscapsule

Articularcartilages

Jointcapsule

Middlephalanx

Synovialmembrane

Figure 9.5

9-15

General Anatomy• articular cartilage – layer of hyaline cartilage that covers the

facing surfaces of two bones– usually 2 or 3 mm thick

• joint (articular) cavity – separates articular surfaces

• synovial fluid – slippery lubricant in joint cavity– rich in albumin and hyaluronic acid

– gives it a viscous, slippery texture like raw egg whites

– nourishes articular cartilage and removes waste

– makes movement of synovial joints almost friction free

• joint (articular) capsule – connective tissue that encloses the cavity and retains the fluid– outer fibrous capsule – continuous with periosteum of adjoining

bones

– inner, cellular, synovial membrane – composed mainly of fibroblast-like cells that secrete synovial fluid and macrophages that remove debris from the joint cavity

9-16

General Anatomy• in a few synovial joints, fibrocartilage grows inward from the joint capsule

– articular disc forms a pad between articulating bones that crosses the entire joint capsule

• temporomandibular joint, distal radioulnar joints, sternoclavicular and acromioclavicular joints

– meniscus – in the knee, two cartilages extend inward from the left and right but do not entirely cross the joint

• these cartilages absorb shock and pressure

• guide bones across each other

• improve the fit between bones

• stabilize the joints, reducing the chance of dislocation

• accessory structures associated with synovial joints– tendon – a strip or sheet of tough collagenous connective tissue that attaches

muscle to bone• the most important structures in stabilizing a joint

– ligament – similar tissue that attaches one bone to another

– bursa – a fibrous sac filled with synovial fluid, located between adjacent muscles, where tendon passes over bone, or between bone and skin

• cushion muscles, helps tendons slide more easily over joints, modify direction of tendon pull

– tendon sheaths – elongated cylindrical bursae wrapped around a tendon• in hand and foot

9-17

Tendon Sheaths and BursaeCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Tendon of flexor pollicis longus

Radial bursa (cut)

Flexor retinaculum (cut)

Ulnar bursa (cut)

Lumbrical muscles

Tendon of flexor carpi radialis

Tendon sheaths

Tendon sheath (opened)

Tendon of flexor digitorumsuperficialis

Tendon of flexor digitorumprofundus

Tendons of flexor digitorum superficialisand flexor digitorum profundus

Tendons of flexor digitorumsuperficialis

Figure 9.6

Exercise and Articular Cartilage• exercise warms synovial fluid

• becomes less viscous and more easily absorbed by articular cartilage

• cartilage then swells and provides a more effective cushion against compression

• warm-up period before vigorous exercise helps protect cartilage from undue wear and tear

• repetitive compression of nonvascular cartilage during exercise squeezes fluid and metabolic waste out of the cartilage

• when weight removed, cartilage absorbs synovial fluid like a sponge taking in oxygen and nutrients to the chondrocytes

• without exercise, cartilage deteriorates more rapidly from inadequate nutrition and waste removal

9-18

9-19

Joints and Lever Systems

• long bones act as levers to enhance the speed or power of limb movements

• lever – any elongated, rigid object that rotates around a fixed point called a fulcrum

• rotation occurs when an effort applied overcomes resistance (load) at some other point– resistance arm and effort arm are described relative to fulcrum


Resistance arm

F

RE

Effort arm

Fulcrum

Effort

Resistance(load)

Figure 9.7

9-20

Mechanical Advantage

• advantage conferred by a lever can be of two kinds:– to exert more force against a resisting object than the

force applied to the lever• human moving a heavy object with help of crowbar

– to move the resisting object farther or faster than the effort arm is moved

• movement of rowing a boat• a single lever cannot confer both advantages

– as one increases, the other decreases

• mechanical advantage (MA) of a lever – the ratio of its output force to its input force

9-21

Mechanical Advantage

• mechanical advantage is calculated from the length of the effort arm divided by the length of the resistance arm

• MA > 1.0 – the lever produces more force, but less speed and distance, than the force exerted on it

• MA < 1.0 – the lever produces more speed or distance, but less force, than the input

• contraction of the biceps brachii muscle puts more power into the lever than we get out of it, but the hand to move faster and further (MA <1.0)

Figure 9.8


Biceps brachii

50 mm 0.15= ==

330 mm

Low mechanical advantageLow powerHigh speed

(a) (b)

E

R

F

F

Radius

High mechanical advantageHigh powerLow speed

Coronoid process

Condyloid process

Resistance arm (LR = 35 mm)

Effort arm (LE = 95 mm)

E

R

Digastric muscle

Res

ista

nce

arm

(LR =

330

mm

)

Effo

rt a

rm (L

E =

50 m

m)

MALE

LR

95 mm 2.7= ==

35 mmMA

LE

LR

Temporalis muscle

9-22

First-Class Lever

• has fulcrum in the middle between effort and resistance (RFE)

• atlanto-occipital joint lies between the muscles on the back of the neck and the weight of the face– loss of muscle tone occurs when you nod off in class


F

E

Fulcrum

Resistance Effort

(a) First-class lever

R

R

F

E

Fulcrum

Effort

Resistance

Resistance Effort

F

Figure 9.9a

9-23

Second-Class Lever

• resistance between fulcrum and effort (FRE)

• resistance from the muscle tone of the temporalis muscle lies between the jaw joint and the pull of the digastric muscle on the chin as it opens the mouth quickly


Effort Effort

FE E

FulcrumF

Fulcrum

Resistance

(b) Second-class lever

R

R

Resistance

Effort

Resistance

F

Figure 9.9b

9-24

Third-Class Lever

• effort between the resistance and the fulcrum (REF)– most joints of the body

• the effort applied by the biceps muscle is applied to the forearm between the elbow joint and the weight of the hand and the forearm

Figure 9.9c


Effort

Fulcrum

Resistance Effort

(c) Third-class lever

E

FFulcrum

RE

F

RResistance

EffortResistance

F

9-25

Range of Motion• range of motion (ROM) –the degrees through which a

joint can move– an aspect of joint performance– physical assessment of a patient’s joint flexibility

• range of motion determined by:– structure of the articular surfaces

• elbow – olecranon of ulna fits into olecranon fossa of humerus

– strength and tautness of ligaments and joint capsules• stretching of ligaments increases range of motion

• double-jointed people have long or slack ligaments

– action of the muscles and tendons• nervous system monitors joint position and muscle tone

• muscle tone – state of tension maintained in resting muscles

9-26

Axes of Rotation

• a moving bone has a relatively stationary axis of rotation that passes through the bone in a direction perpendicular to the plane of movement

• multiaxial joint - shoulder joint has three degrees of freedom or axes of rotation

• other joints – monoaxial or biaxial


(b) Flexion of arm

(a) Abduction of arm

(c) Internal rotation of arm

Figure 9.10

9-27

Classes of Synovial Joints

Head of humerus

Scapula

Carpal bone

Metacarpal bone PhalanxMetacarpalbone

Humerus

Ulna Carpal bones

Radius

Ulna

Ball-and-socket joint(humeroscapular)

Pivot joint(radioulnar)

Saddle joint(trapeziometacarpal)

Hinge joint(humeroulnar)

Plane joint(intercarpal)

Condylar joint(metacarpophalangeal)


Figure 9.11

9-28

Ball-and-Socket Joints

• smooth, hemispherical head fits within a cuplike socket– shoulder joint - head of humerus into glenoid

cavity of scapula– hip joint - head of femur into acetabulum of

hip bone

• the only multiaxial joints in the body

9-29

Condyloid (ellipsoid) Joints

• oval convex surface on one bone fits into a complementary shaped depression on the other– radiocarpal joint of the wrist – metacarpophalangeal joints at the bases of

the fingers

• biaxial joints – movement in two planes

9-30

Saddle Joints

• both bones have an articular surface that is shaped like a saddle, concave in one direction and convex in the other– trapeziometacarpal joint at the base of the

thumb– sternoclavicular joint – clavicle articulates with

sternum

• biaxial joint– more movable than a condyloid or hinge joint

forming the primate opposable thumb

9-31

Plane (gliding) Joints

• flat articular surfaces in which bones slide over each other with relatively limited movement

• usually biaxial joint– carpal bones of wrist– tarsal bones of ankle– articular processes of vertebrae

• although any one joint moves only slightly, the combined action of the many joints in wrist, ankle, and vertebral column allows for considerable movement

9-32

Hinge Joints

• one bone with convex surface that fits into a concave depression on other bone– elbow joint - ulna and humerus– knee joint - femur and tibia– finger and toe joints

• monoaxial joint – move freely in one plane

9-33

Pivot Joints

• one bone has a projection that is held in place by a ring-like ligament

• bone spins on its longitudinal axis– atlantoaxial joint (dens of axis and atlas)

• transverse ligament

– proximal radioulnar joint allows the radius to rotate during pronation and supination

• anular ligament

• monoaxial joint

9-34

Movement of Synovial Joints

• vocabulary of movements of synovial joints used in kinesiology, physical therapy, and other medical fields– many presented in pairs with opposite or contrasting

meanings– need to understand anatomical planes and

directional terms

• zero position – the position of a joint when a person is in the standard anatomical position– joint movement are described as deviating from the

zero position or returning to it

9-35

Flexion, Extension and Hyperextension

• flexion – movement that decreases the a joint angle– common in hinge joints

• extension – movement that straightens a joint and generally returns a body part to the zero position

• hyperextension – further extension of a joint beyond the zero position– flexion and extension occur at

nearly all diarthroses, hyperextension is limited to a few

Figure 9.12a


(a)

Extension

Flexion

© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer


(b)

Extension

Flexion

Hyperextension

Figure 9.12b


9-36

Flexion, Extension and Hyperextension

Figure 9.12c

Figure 9.12d


(c)

Flexion

Hyperextension



(d)

Hipflexion

Kneeflexion

Extension


9-37

Abduction and Adduction

• abduction - movement of a body part in the frontal plane away from the midline of the body– hyperabduction – raise arm over back or front of head

• adduction - movement in the frontal plane back toward the midline– hyperadduction – crossing fingers, crossing ankles

Figure 9.13a,b


(a) Abduction (b) Adduction© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer

9-38

Elevation and Depression

• elevation - a movement that raises a body part vertically in the frontal plane

• depression – lowers a body part in the same plane

Figure 9.14a,b


(a) Elevation (b) Depression© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer

9-39

Protraction and Retraction

• protraction – the anterior movement of a body part in the transverse (horizontal) plane

• retraction – posterior movement


(a) Protraction

(b) Retraction

Figure 9.15a,b


9-40

Circumduction

• circumduction - one end of an appendage remains stationary while the other end makes a circular motion

• sequence of flexion, abduction, extension and adduction movements– baseball player winding

up for a pitch Figure 9.16



9-41

Rotation

• rotation – movement in which a bone spins on its longitudinal axis– rotation of trunk, thigh,

head or arm

• medial (internal) rotation turns the bone inwards

• lateral (external) rotation turns the bone outwards

Figure 9.17a,b


(b) Lateral (external) rotation(a) Medial (internal) rotation


9-42

Supination and Pronation• primarily forearm movements

• supination – forearm movement that turns the palm to face anteriorly or upward– forearm supinated in anatomical

position– radius is parallel to the ulna

• pronation – forearm movement that turns the palm to face posteriorly or downward– radius spins on the capitulum of

the humerus– disc spins in the radial notch of

ulna– radius crosses stationary ulna

like an XFigure 9.18a,b


(a) Supination (b) Pronation© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer

9-43

Movements of Head and Trunk

flexion, hyperextension, and lateral flexion of vertebral column

Figure 9.19a,b,c


(a) Flexion (b) Hyperextension (c) Lateral flexion


9-44

Rotation of Trunk and Head

right and left rotation of trunk right and left rotation of head

Figure 9.19d,e



9-45

Special Movements of Mandible

• lateral excursion – right or left movement from the zero position• medial excursion - movement back to the median, zero position

– side-to-side grinding during chewing

• protraction – retraction elevation - depression

Figure 9.20


(a) Protraction (b) Retraction

(c) Lateral excursion (d) Medial excursion


9-46

Special Movement of Hand and Digits

• ulnar flexion – tilts the hand toward the little finger

• radial flexion – tilts the hand toward the thumb

• flexion of fingers – curling them• extension of fingers – straightening

them• abduction of the fingers – spread

them apart• adduction of the fingers – bring them

together again• flexion of thumb – tip of thumb

directed toward palm• extension of thumb – straightening

the thumb• radial abduction – move thumb away

from index finger 90°• palmar abduction – moves thumb

away from hand and points it anteriorly• adduction of thumb – moves it to the

zero position• opposition – move the thumb to touch

the tips of any of the fingers• reposition – return the thumb to the

zero position Figure 9.21


(a) Radial flexion (b) Ulnar flexion

(d) Palmar abduction of thumb (e) Opposition of thumb

(c) Abduction of fingers


9-47

Special Movements of the Foot

• dorsiflexion – elevation of the toes as you do while swinging the foot forward to take a step (heel strike)

• plantar flexion - extension of the foot so that the toes point downward as in standing on tiptoe (toe-off)

• inversion - a movement in which the soles are turned medially• eversion - a movement in which the soles are turned laterally• supination of foot – complex combination of plantar flexion, inversion, and

adduction• pronation of foot – complex combination of dorsiflexion, eversion, and abduction


Figure 9.22© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer

Dorsiflexion

Zeroposition

(c) Eversion(b) Inversion

Plantar flexion

(a) Flexion of ankle

Temporomandibular Joint

• temporomandibular (jaw) joint (TMJ) – articulation of the condyle of the mandible with the mandibular fossa of the temporal bone

– combines elements of condylar, hinge, and plane joints

– synovial cavity of the TMJ is divided into superior and inferior chambers by an articular disc

– two ligaments support joint• lateral ligament – prevents posterior displacement of mandible• sphenomandibular ligament – on the medial side

– deep yawn or strenuous depression can dislocate the TMJ• condyles pop out of fossa and slip forward• relocated by pressing down on molar teeth while pushing the jaw

backward

9-48

Temporomandibular JointCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Joint capsule

Styloid process

(a) Lateral view

(c) Sagittal section(b) Medial view

Occipital bone

Sphenoid sinus

Styloid process

Joint capsule

Synovial membrane

Mandibular condyle

Superior joint cavity

Inferior joint cavity

Articular disc

Sphenomandibularligament

Lateralligament

Externalacoustic meatus

Stylomandibularligament

Mandibular fossaof temporal bone



Figure 9.23 9-49

9-50

TMJ Syndrome• temporomandibular joint (TMJ) syndrome

– may affect as many as 75 million Americans

• signs and symptoms– can cause moderate intermittent facial pain– clicking sounds in the jaw– limitation of jaw movement– often severe headaches, vertigo (dizziness),

tinnitus (ringing in the ears)– pain radiating from jaw down the neck,

shoulders, and back

• cause of syndrome– caused by combination of psychological

tension and malocclusion (misalignment of teeth)

• treatment – psychological management, physical

therapy, analgesic and anti-inflammatory drugs, corrective dental appliances to align teeth properly

Figure 9.23 a,c


Joint capsule

Styloid process

(a) Lateral view


Lateralligament

Externalacoustic meatus



(c) Sagittal section

Joint capsule

Synovial membrane

Mandibular condyle

Superior joint cavity

Inferior joint cavity

Articular disc

Mandibular fossaof temporal bone

9-51

The Shoulder Joint• glenohumeral (humeroscapular) joint – the

hemispherical head of the humerus articulates with the glenoid cavity of the scapula

– the most freely movable joint in the body– shallow glenoid cavity and loose shoulder

joint capsule sacrifice joint stability for freedom of movement

– glenoid labrum – fibrocartilage ring that deepens glenoid cavity

• shoulder supported by biceps brachii tendon anteriorly and also the rotator cuff tendons

– tendons fuse to joint capsule and strengthens it

– supraspinatus, infraspinatus, teres minor and subscapularis

• five principal ligaments support shoulder– three are called the glenohumeral

ligaments– coracohumeral ligament– transverse humeral ligament

• four bursa occur at the shoulder– subdeltoid, subacromial, subcoracoid,

and subscapular bursae

Figure 9.24c


Glenoid labrum

Glenoid labrum

Supraspinatus tendon

Acromion

Capsular ligament

Humerus

(c) Frontal section

Subdeltoidbursa

Deltoidmuscle Synovial

membrane

Glenoid cavityof scapula

9-52

Stabilizers of the Shoulder Joint

Figure 9.24b


Acromion

Tendon sheath

Humerus

ClavicleAcromioclavicular ligament

Subacromialbursa

Supraspinatustendon

Coracohumeralligament

Subdeltoidbursa

Subscapularistendon

Transversehumeralligament

Biceps brachiitendon(long head)

(b) Anterior view

Glenohumeralligaments

Subscapularbursa

Subcoracoidbursa

Coracoidprocess

Coraco-acromialligament

Coraco-clavicularligament

9-53

Tendons of Rotator Cuff Muscles

Figure 9.24d


Coracoid process

Coracohumeral ligament

Subscapular bursa

Subscapularis tendon

Acromion

Supraspinatustendon

Subdeltoidbursa

Infraspinatustendon

Glenoid cavity(articular cartilage)

Synovial membrane(cut)

Teres minortendon

(d) Lateral view , humerus removed

Inferior glenohumeralligament

Middle glenohumeralligament

Biceps brachii tendon(long head)

Superior glenohumeralligament

9-54

Shoulder Dislocation• very painful and sometimes cause

permanent damage

• downward displacement of the humerus is the most common shoulder dislocation– rotator cuff protects the joint in all

directions but inferiorly– joint protected from above by

coracoid process, acromion, and clavicle

• dislocations most often occur when the arm is abducted and then receives a blow from above

• children especially prone to dislocation Figure 9.24c


Glenoid labrum

Glenoid labrum

Supraspinatus tendon

Acromion

Capsular ligament

Humerus

(c) Frontal section

Subdeltoidbursa

Deltoidmuscle Synovial

membrane

Glenoid cavityof scapula

9-55

Dissection of Shoulder Joint

Figure 9.24a


Clavicle

Acromion of scapula

Head of humerus

Biceps brachii muscle:Short headLong head

Acromioclavicularjoint

Coracobrachialismuscle

Deltoid muscle(cut and folded back)

Pectoralis majormuscle

(a) Anterior dissection© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer

9-56

The Elbow Joint

Figure 9.25c

• elbow is a hinge joint composed of two articulations:

– humeroulnar joint – where the trochlea of the humerus joins the trochlear notch of the ulna

• hinge joint– humeroradial joint – where the

capitulum of the humerus meets the head of the radius

• pivot joint• edge of the disc-like head of the

radius fits into the radial notch of the ulna

• anular ligament holds the head in place

• radial head rotates like a wheel against the ulna as the forearm is supinated and pronated

• both enclosed in a single joint capsule

• olecranon bursa – on posterior side of the elbow

– eases the movement of the tendons over the joint

• side-to-side motion of the elbow is restricted by a pair of ligaments

– radial (lateral) collateral ligament– ulnar (medial) collateral ligament


(b) Sagittal section

Humerus

Trochlea

Joint capsule

Radius

Olecranon

Articular cartilage

Coronoid process

Ulna

Olecranonbursa

Figure 9.25bCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

(c) Medial view

Anular ligament

Joint capsule

Humerus

Coronoid process

Radius

Ulna

Tendon oftriceps brachii

Ulnar collateralligament

Olecranonbursa

Tendon of bicepsbrachii (cut)

9-57

Elbow Joint

Figure 9.25d

(a) Anterior view

Joint capsule

Humerus

Radius

Ulna

Lateralepicondyle

Radial collateralligament

Anularligament

Tendon ofbiceps brachii(cut)

Medialepicondyle

Ulnar collateralligament


Figure 9.25a


(d) Lateral view

Joint capsule

Humerus

Olecranon

Anular ligament

Radius

Ulna

Joint capsule

Tendon ofbiceps brachii(cut)

Lateralepicondyle

Radialcollateralligament

9-58

The Coxal (Hip) Joint

• coxal (hip) joint – point at which the head of femur inserts into the acetabulum of the hip bone

• bears much more weight, have deeper sockets, more stable than shoulder

• acetabular labrum – horseshoe-shaped ring of fibrocartilage that deepens socket

– dislocations rare: congenital dislocations in infants

• ligaments supporting hip joint– iliofemoral and pubofemoral – on anterior– ischiofemoral ligament – on posterior– when standing, the ligaments become

twisted and pull head of femur tightly into the acetabulum

– transverse acetabular ligament – bridges gap on inferior margin of acetabular labrum

• fovea capitis – pit on the head of femur

– round ligament, or ligamentum teres – arises from here and attaches to the lower margin of the acetabulum

– contains artery that supplies blood to the head of the femur

Figure 9.26b


Acetabulum

Labrum

Femur

Roundligament (cut)

Foveacapitis

Head offemur

Greatertrochanter

Transverseacetabularligament

Ischialtuberosity

Obturatormembrane

(b) Lateral view, femur retracted

9-59

Hip (Coxal) Joint

Figure 9.26c,d


Ilium

Femur

Pubis

Pubofemoralligament

Iliofemoralligament

Greatertrochanter

Lessertrochanter

(c) Anterior view

Femur

(d) Posterior view

Iliofemoralligament

Ischiofemoralligament

Greatertrochanter

Ischialtuberosity


9-60

Dissection of Hip Joint

Figure 9.26a


Acetabular labrum

Acetabulum

Round ligament

Head of femur

Greater trochanter

Shaft of femur

(a) Anterior dissection© The McGraw-Hill Companies, Inc./Timothy L. Vacula, photographer

9-61

Treatment of Congenital Hip Dislocation

•Depends on the child’s age. •In a newborn or very young infant - a soft positioning device called a Pavlik harness will keep the hip bone in the socket and stimulate normal hip development•Closed reduction - the hip bone can often be pushed back into place in children aged 6 months to 2 years. (under anesthesia). If closed reduction is no longer an option.•Open surgery - to reposition the hip (the child is over 2 years of age),

Following - the child will wear a cast and/or braces for several months, to help keep the hip bone in the socket while it heals.

(Very young children may experience a delay before walking because of the cast. Although a difference in leg lengths may remain, early treatment of congenital hip dislocation can promote normal hip joint function and ultimately permit an active lifestyle)

http://www.zimmer.com/z/ctl/op/global/action/1/id/7989/template/PC/navid/167

9-62

The Knee Joint• tibiofemoral (knee) joint – largest and most

complex diarthrosis of the body

• primarily a hinge joint– capable of slight rotation and lateral

gliding when knee flexed– patellofemoral joint – gliding joint

• joint capsule encloses only the lateral and posterior aspects of the knee, not the anterior

– anterior covered by patellar ligament and lateral and medial retinacula

• all are extensions of the tendon of quadriceps femoris muscle

• knee stabilized:– quadriceps tendon in front– tendon of semimembranosus muscle on

rear side of thigh

• joint cavity contains two C-shaped cartilages– lateral meniscus and medial meniscus– joined by transverse ligament

• absorbs shock on the knee• prevents femur from rocking side-to-

side on the tibia

Figure 9.29c


Femur

Meniscus

Tibia

Joint cavity

Infrapatellar fat pad

Synovial membrane

Patellar ligament

Patella

Prepatellar bursa

Articular cartilage

Joint capsule


Bursa under lateralhead of gastrocnemius

Quadricepsfemoris

Quadricepsfemoris tendon

Suprapatellarbursa

Superficialinfrapatellar bursa

Deepinfrapatellar bursa

9-63

The Knee Joint• popliteal region of knee

– supported by a complex array of: – extracapsular ligaments – external to joint

capsule• prevent knee from rotating when joint is

extended• fibular (lateral) collateral ligament• tibial (medial) collateral ligament

– two intracapsular ligaments deep within joint capsule

• synovial membrane folds around them, so they are excluded from the fluid filled synovial cavity

• ligaments cross each other to form an X• anterior cruciate ligament (ACL)

– prevents hyperextension of knee when ACL is pulled tight

– one of the most common sites of knee injury• posterior cruciate ligament (PCL)

– prevents femur from sliding off tibia– prevents the tibia from being displaced

backward

• ability to “lock” the knees– important aspect of human bipedalism– when knee is extended to the fullest degree

allowed by ACL• femur rotates medially on the tibia• locks the knee, and all major knee ligaments

are twisted and taut– “unlock” knee – popliteus muscle rotates

the femur laterally and untwists the ligaments

Figure 9.29c


Femur

Meniscus

Tibia

Joint cavity


Synovial membrane

Patellar ligament

Patella

Prepatellar bursa

Articular cartilage

Joint capsule



Quadricepsfemoris


Suprapatellarbursa



Knee Joint – Sagittal Section

• knee joint has at least 13 bursae• four anterior: superficial infrapatellar, suprapatellar, prepatellar,

and deep infrapatellar• popliteal region: popliteal bursa and semimembranosus bursa• seven more bursae on lateral and medial sides of knee joint 9-64

Figure 9.29c


Femur

Meniscus

Tibia

Joint cavity


Synovial membrane

Patellar ligament

Patella

Prepatellar bursa

Articular cartilage

Joint capsule



Quadricepsfemoris


Suprapatellarbursa



9-65

Knee Joint – Anterior and Posterior Views

Figure 9.29a,b

Femur

Patellar surface

Medial condyle

Fibula

Tibia

Medial meniscus

(a) Anterior view

Lateralcondyle

Fibularcollateralligament

Lateralmeniscus

Transverseligament

Posterior cruciateligament

Anterior cruciateligament

Tibial collateralligament

Patellar ligament(cut)

(b) Posterior view

Femur

Fibula

Tibia

Lateral meniscus


Fibular collateralligament

Articular cartilageof tibia

Medialcondyle

Tibialcollateralligament

Medialmeniscus

Posteriorcruciateligament

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

9-66

Knee Joint – Superior View

• medial and lateral meniscus absorb shock and shape joint

Figure 9.29d


Medial meniscus

Lateral meniscus

(d) Superior view of tibia and menisci

Posterior cruciateligament

Synovialmembrane

Medial condyleof tibia


Lateral condyleof tibia

9-67

Dissection of Knee Joint

Figure 9.28


Femur:ShaftPatellar surface

Medial condyle

Lateral condyle

Joint cavity:

Joint capsule

Medial meniscus

Lateral meniscus

Lateral condyle

Tuberosity

Medial condyle

Patellar ligament

Articular facets

Lateral Medial


Patella(posterior surface)

Quadricepstendon (reflected)

© The McGraw-Hill Companies, Inc./Rebecca Gray, photographer/Don Kincaid, dissections

Tibia:

Knee Injuries

• highly vulnerable to rotational and horizontal stress

• most common injuries are to the meniscus and anterior cruciate ligament (ACL)

• heal slowly due to scanty blood flow

• arthroscopy – procedure in which the interior of the joint is viewed with a pencil-thin arthroscope inserted through a small incision

– less tissue damage than conventional surgery

– recovery more quickly– arthroscopic ACL repair – about nine

months for healing to be complete


Foot fixed

Patellar ligament

Twisting motion

Anterior cruciateligament (torn)

Tibial collateralligament (torn)

Medialmeniscus (torn)

Figure 9.30 9-68

The Ankle Joint• talocrural (ankle) joint – includes two articulations:

– medial joint – between tibia and talus

– lateral joint – between fibula and talus

– both enclosed by one joint capsule

– malleoli of tibia and fibula overhang the talus on either side and prevent side-to-side motion

– more restricted range of motion than the wrist

• ankle ligaments– anterior and posterior tibiofibular ligaments – bind the tibia to fibula

– multipart medial (deltoid) ligament – binds the tibia to the foot on the medial side

– multipart lateral (collateral) ligament – binds fibula to the foot on the lateral side

– calcaneal (Achilles) tendon – extends from the calf muscle to the calcaneus

• plantarflexes the foot and limits dorsiflexion

– sprains (torn ligaments and tendons) are common at the ankle• pain and immediate swelling

9-69

9-70

Ankle Joint and Foot Ligaments

Figure 9.31a,c,d


Posterior tibiofibularligament

Lateral malleolus

Posterior talofibularligament

Calcaneofibularligament

Calcaneus

(d) Posterior view

Medialmalleolus

Interosseousmembrane

Fibula

Tibia

Calcanealtendon

Calcaneus

Tibia

Tendons oftibialis anterior and posterior

Metatarsal I

Navicular

Medial ligament

(c) Medial view

Calcaneofibular ligament

Anterior talofibular ligament

Posterior talofibular ligament

Tendons offibularis longusand brevis

Metatarsal v

Calcaneus

Calcanealtendon

Anterior andposterior tibiofibularligaments

Tibia

Fibula

(a) Lateral view

Lateral ligament:

9-71

Dissection of the Foot

Figure 9.31b


Anterior talofibular ligament

(b) Lateral dissection

Calcaneofibular ligament

© L. Bassett/Visuals Unlimited

9-72

Arthritis• arthritis - a broad term for pain and inflammation of

a joint

• most common crippling disease in the United States

• rheumatologists – physicians who treat arthritis and other joint disorders

• osteoarthritis (OA) – most common form of arthritis– ‘wear-and-tear arthritis’– results from years of joint wear– articular cartilage softens and degenerates– accompanied by crackling sounds called crepitus– bone spurs develop on exposed bone tissue causing pain

9-73

Arthritis and Artificial Joints

• rheumatoid arthritis (RA) - autoimmune attack against the joint tissues– misguided antibodies (rheumatoid factor) attack

synovial membrane, enzymes in synovial fluid degrade the articular cartilage, joint begins to ossify

– ankylosis – solidly fused, immobilized joint– remissions occur, steroids and aspirin control

inflammation

• arthroplasty - the replacement of diseased joint with artificial device called prosthesis

9-74

Rheumatoid ArthritisCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

(b)CNRI/Science Photo Library/Photo Researchers, Inc. Figure 9.32b

9-75

Joint ProsthesesCopyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Femur

(a)

(b)

(c)

(d)

Fibula

Femur

Prosthesis

Artificialacetabulum

Artificialfemoralhead

Tibia

a: © SIU/Visuals Unlimited; b: © Ron Mensching/Phototake; c: © SIU/Peter Arnold, Inc.; d: © Mehau Kulyk/SPL/Photo Researchers, Inc.

Figure 9.33a,b Figure 9.33c,d

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